Women with a family history of breast cancer are at substantially increased risk for developing the disease themselves. The most effective method for decreasing the risk of breast cancer mortality in this population. is adherence to recommended guidelines for breast cancer screening. However, a significant percentage of these women do not adhere to these guidelines. Improving the rate of screening adherence is a major challenge for breast cancer prevention and control researchers. To develop effective strategies for increasing adherence, we must identify the variables that are predictive of it. One such variable may be psychological distress. Recent, retrospective, studies have suggested that a negative relationship may exist between psychological distress and breast cancer screening adherence among high risk women. However, this relationship has yet to be demonstrated in a longitudinal study. The present study will be the first to test this relationship prospectively among a sample of women with a family history of breast cancer. We will further examine the variables that predict distress, and the processes linking distress with adherence. We will recruit 250 women with a family history of breast cancer in one or more first degree relatives (mother, daughter, or sister). Participants will be recruited from two sites. We will accrue an ethnically and socioeconomically diverse sample. We will assess psychological distress, adherence to mammography, and adherence to breast self-examination at baseline and year later. We will assess hypothesized antecedent and mediating variables at baseline. The results of this project will be used to develop future interventions. These interventions will target the individuals most vulnerable to psychological distress and subsequent non-adherence. In addition, these interventions will be designed to modify the processes that are found to predict distress and non-adherence.